The Malayali Nurse on the Moon

In February 2011, bodies of anti-Gaddafi protesters piled up in Tripoli hospital mortuaries, then spilt out in heaps into the corridors, onto empty table tops. A few days later came the stories of Libyan soldiers invading hospitals and ripping off patients’ oxygen masks, the wires connected to their monitors,their drips, their tubes, and taking them away.

Of the 18,000 Indians in Libya at the time, news reports say the majority were young Malayali nurses bandaging and swabbing the civil war. When the Indian government began evacuation of its citizens from Libya, many of these nurses were surprisingly reluctant to leave. Repatriated and living temporarily in Delhi, they roamed around Kerala House like ghosts wondering whether they’d had made a mistake. They talked about the loans they had taken for their courses, the fact that even big city hospitals in India think nothing of making a nurse work 65 hour weeks for Rs 3000 per month, their parents in rural Kerala. Who’d argue with them? By now, many of them are back in Libya.

You can put the Malayali nurse in the old teashop-on-the-moon comic scenario and the joke would still work. She is everywhere. She is rattling in a second-hand Japanese car, driving 150 km from Jebel Akdhar to Muscat to do her weekly shopping. She is all five of the thin, young women hovering behind and managing the mercurial, bejewelled Sardar doctor who looks outraged that he’s stuck in this dreary Bombay clinic. She is speaking German fluently in Cologne and struggling with English as she begins the process of emigration to the US. She is standing in INA market in Delhi with her friend, under a big sign proclaiming in Malayalam ‘Saudi nurse uniform thaiyar’. She is throwing on a hijab as she leaves her Jeddah home. She is the nurse in Delhi who was fired for speaking Malayalam in the lift when she asked her off-duty pal, “Pallil ponno?” She is also the nursing superintendent who fired her. She is the one who made everyone laugh at the idea of a nurse not speaking Malayalam.

She is everywhere, so it becomes difficult to see her. At some point you have to squint to see past the chimera that is the Malayali nurse. You have to ask why even Libya — broken, bullet-scarred and currently in possession of 14 psychiatrists for the whole nation — is a better choice than any place in India? You have to ask why she chooses nursing at all. And if we don’t see her as a martyr to the family coffers, who is the woman emerging out of the smoke then?

Nobody’s Servant
When Karen Arrakal told her school friends that she had decided to train as a nurse, they were appalled. “Apne Bombaywale think a nurse is like a servant. They are sort of ok with the idea of giving medicines or injections but shocked that I was going to bathe strangers. If only they knew that in a night I have four bed baths of which two will be on ventilators. In the same night I may have to resusciate a collapsed patient through chest compression, move bed-ridden patients and give them back massages.”

Twenty-three-year-old Karen Arrakal sounds and looks like any other Mumbai girl, but as Nurse Karen of Holy Spirit Hospital, Andheri, she is a different person. Nurse Karen grew up in her aunt’s house in Mumbai while her parents struggled in small-town Gujarat. “My mother was a typist. My father lost his job and it caused problems in their relationship.” In Mumbai, she grew up in thrall of her cousin Shalini, 13 years older. Shalini trained as a nurse and in that ideal trajectory hit California and saved her family. This is Karen’s plan too. She is contemplating Australia.

Understaffed. Overworked. Underpaid. You can drown in their stories. The nurse told by her private hospital employers to prove that she really was away at her mother’s funeral because ‘this obituary in the paper could be anybody’s mother’. The nurse who died after she contracted dengue at work and went undiagnosed for a week. The many nurses who feel faint after three back-to-back surgeries without a meal and no longer have the stamina to fully sterilise instruments so just dip them in hot water. You begin to wonder how Indian hospitals manage to find any nursing staff at all and why anyone but the most desperate of young women would choose this profession. But all kinds of Malayali girls register as nurses every year.

Karen and others make it sound like an obvious choice even though it is complicated. Even Karen’s father has the mixed feelings most Malayalis have about nursing. Contempt, pragmatism, admiration for martyrdom, admiration for materialism, and contempt again. But a nurse abroad is a far, far better thing than a nurse at home. Over the decades lakhs of 18-year-old girls have left their villages to become nurses bolstered by the cultural expectation of becoming angel or slut and either way, the heroine of maudlin weepies. But nurses have discovered along the way that they can be cowboy, gold miner or nun. They can be adventure-loving, power-seeking and hugely independent.

Take Reni. She is 25, a nurse in a south Delhi clinic. If she likes the look of your face she will warn you that the elderly doctor inside is a shark who over-prescribes. Take his prescription and run, she hisses in Malayalam. She’s been here two months but really, her last job in a small town in Madhya Pradesh was better than this! This man is so kanjoos, she complains. And he makes her stay in the tiny room behind the clinic. She is so bored and starved of company.

Like Karen, Reni had wanted to go to Australia after her last stint but her military nurse grandmother wanted her to get married first. 25-year-old Reni comes from a family of army nurses who’ve lived everywhere and done everything. And unlike the tragic army nurse protagonist of the 1968 KR Vijaya starrer Anveshichu Kandethiyilla, Reni feels in complete control of her life. (Aside: look for the film to hear KR Vijaya belt out song and dialogue in Hindi.)

Reni thinks she can stall her grandmother. Perhaps there is some place she can join in Delhi while she waits for Australia to happen. Recently Reni asked the newspaper delivery boy to drop off the English papers for her so she could check out the classifieds. After a week of not getting the newspaper and screaming at the protesting delivery boy Rene did some detective work. The doctor was stealing the paper in the morning before she could get to it. War was on. “I’m not afraid of that old guy,” she says, gesturing at the doctor’s door. “The first glimmer of a decent job and I’m out of here.”

In a 1990s serialised paingili novel, the nurse fresh from Kerala arrives in Bombay and plunges into the most heated circles of high society. Perhaps it’s a false memory but I remember the nurse arriving at a rave party the very first night she’s in Bombay and being scandalised by the advances of a short-haired lesbian. Even as a schoolchild, this seemed like a rather accelerated case of social mobility to me. However, beyond the narrative of bearing the cross of the family, nursing has always had an irresistible mixture of ‘good girl’ humanitarianism and ‘bad girl’ adventure. Karen could have joined a BPO if she wanted to. She is Anglophone enough. But she talks easily and unpretentiously about wanting to do a job that helps people (an unintentionally hilarious indictment of call centres). She thinks nothing of saying, “ I believes in service.’

Thirty five years ago Payapilly Joseph Mary had made the same decision. Even then she had other, if tamer, options. She trained as a nursery school teacher and taught for a few months. Nursing, she thought, was a profession that combined dignity, service and provided security. She joined the nursing college attached to the Government Medical college in Bellary, Karnataka. She worked in Hubli and then in Bangalore. The word ‘service’ has always been an important part of how she approaches the nursing profession. She uses it interchangeably with ‘vocation’.

Living in Bangalore today, retired and struggling gamely with sarcoidosis, a chronic lung disease, she says, “After doing nursing for 35 years, I can’t imagine what life might have been like without it. If I hadn’t been a nurse it would have been a struggle to resist being married off in a small village. Nursing was a way of seeing the outside world, of travelling, of working. I enjoyed meeting interesting people. Without my batchmates at nursing school, colleagues, doctors, patients, my life would have been less rich, less fulfilling. Today, nursing even helps me cope with my own illness.”

Mary remembers the fun of being in a hostel full of working women, the thrill of being independent, of dutifully sending money home but also buying sarees, jewellery and how for 2 years in Hubli she saw a movie a week in a theatre close to the hospital.

A rather glamorised but still affectionate portrait of this life of sisterhood and cameraderie was evident in the first quarter of the 2012 movie 22 Female Kottayam. Though protagonist Tessa K Abraham’s fancy-schmancy flat and equally fancy-schmancy lifestyle in Bangalore must have made young nurses watching the movie guffaw. To be fair to her, she does say ‘I was born to be a nurse’ with heartwarming sincerity. Later in a neat display of her advanced surgical skills she performs a penectomy on the recruitment agency villain, dutifully waits for him to heal from the procedure and catches the evening flight to Canada.

The Flying Nurse
The Malayali nurse in the popular narrative saves the family like Shalini and Karen – but the salvation is uniquely anarchic. From the outside, the ‘saved’ family resembles nothing like the traditional families the rest of India knows. Families in which husbands stay in India waiting for a spouse visa. Or children seeing their mothers once a year. In which women build homes, fund weddings, educate their siblings and earn more than their husbands. In which a one-month old child is left with his grandparents as the mother returns to the small clinic in Oman where she works and uses frozen cabbage leaves inside her bra to dry her breast milk. In many ways, the story of the Malayali nurse is the story of Kerala – its flight of labour and the skewed, strange society we have created. Successive generations of Malayalis (not just the progeny of nurses) have grown up without their parents. They have grown into adults without parenting skills and this, we can speculate uselessly, is at the heart of the depressive, suicidal Malayali.

The nurse from Kerala has her own variation on the work-life balance problem though it is never stated overtly. Karen suspects she’ll miss home, but she’s also excited about going abroad. She has a boyfriend who doesn’t want to go to Australia. He is a doctor training to be a consultant and doesn’t need to go abroad. (This is true since the freakishly huge new medical empires in the metros do not include proportionate investment in nurses but do include the avid seduction of consultants.) Her doctor-nurse romance is an unusual one that can have its own complicated power equation, agrees Karen. ‘We treat each other as equals,’ she elaborates, ‘since we are both students now we are both on the same learning curve. Once he qualifies a consultant only then can he order me about at work.’ And what about adding a long distance relationship to the mix? Like the women who bolted back to Libya, Karen knows generations of women whose entire marriages were conducted long distance so she doesn’t sound panicked. “I picked Australia because the US is now closing doors to Indian nurses. My boyfriend? He may change his mind about Australia, but if he doesn’t I’ll come and visit.”

While Karen is playing it by ear, many nurses would sympathise with the the tough bargaining Mary did in the 1970s to retain her freedom. She met Issac when he was working with a company that installed and maintained the elevators at Karnataka Medical College in Hubli. Every fortnight he came from Bangalore to Hubli to inspect and service the elevator connected to the operation theatres. Mary worked there and at first found him irritating and ignored him. They met again at church on the following Sunday. Issac walked back with her to the nurses’ hostel.

Though Mary grew to like Issac, she was wary of being seen as another ‘loose’ nurse. (Like just another loose receptionist, stewardess, waitress, actor, any woman whose job takes her to the public.) By then she had seen her share of friends in disastrous relationships and suicide attempts. Mary’s children have often heard her talk of finding her own model of being a strong woman, of the difficulties of working and living far from home but constantly living with the confusion of impending marriage. And — this was a big one — worrying that the marriage was going to be based on the money she was bringing into it. Some women were comforted that as nurses, they were exempt from having to shell out a big dowry. Others like Mary were made miserable by these sharp and public assessments of their worth.

Finally, Mary decided Issac was not a ‘dangerous’ type and agreed to explore marriage in the vague future. They got married two years after they met on the condition that Issac would never ask her to give up work and would never want control over her money. This is something they managed to hold onto all of Mary’s working life. Even after being diagnoised with sarcoidosis she worked for 3 years till superannuation. “Dad never asked her to give up work, even when my sister Bindu or I casually tried mentioning it,” says her son Benson. “He made sure whenever he could he dropped her at the hosptial and picked her up after work.” Benson, who currently teaches at the Azim Premji University says, “My distinct memory is of Dad ironing her nurses cap after stretching it. He was the expert in making it stand crisp without a single part crumpled. I use to love collecting the imitation mother-of pearl buttons that were on nurses’ uniforms when I was a child.” All her life Mary has resisted the dominant narrative of martyrdom and laughed at hints from gentrifying relatives ‘that girls from good families shouldn’t do nursing any more.’ Her good girl-bad girl legacy has made her children balance their careers on the restless edge of development and academia. Benson adds, “She insisted Bindu and I learn Kannada. She felt her effort to speak, read and write in Kannada made work more meaningful. She felt this was most critical – to be able to reach out to people, make them comfortable and not be distant and professional.”

Annies Kanmani Joy, the first nurse to get into the Indian Civil Services in 2012

Why Tripoli?
Look again at the news from Libya. Some of the nurses stayed because they were sure things would get better. Some because they were sure they couldn’t afford tickets back if things got better. Some because their employers had their passports. The process of normalisation of exploitative labour across the Gulf will ensure that few Malayalis will twitch at this last bit of information.

Step outside this circle a bit and you feel the shock. “They take your passports away?” Step away further and you see why many Malayali nurses think Libya is no more repressive than most private hospitals in India. Shejy, 40, left Libya last year with her family before the worst of the violence. This year she returned to the highly specialised paediatric ICU unit of Tripoli Medical Centre where she has worked for 8 years. She is unfazed at the thought of the civil war. “It’s not like in India there aren’t any bombs or shootings,” she reasons. Her husband and children are still in Kerala but hope to join her in a while. While she was waiting for the recall from Libya she worked for a few months in a hospital in Kerala and was utterly fed up. “I’ve no idea how I did it before. The politics, the harrassment, the low standards of hygiene. Also they thought nothing of paying Rs 3500 to a nurse with 15 years experience. And if you complain about any of these things they tell you to take it or leave it.”

And in most private hospitals in India, Shejy would have had to hand over her precious educational certificates too. Over the last five years the Delhi-based Nurses Welfare Association of India (formerly the Malayali Nurses Welfare Association) has dealt with nearly 5000 cases of nurses fighting to get their certificates back from their employers. Without their certificates they are hobbled and unable to even attend job interviews. “Hospitals will sometimes hold on to a nurse’s certificates for years after they’ve left the job on the slightest pretext and sometimes demand as much as Rs 50,000 to return them,” says Usha Krishna Kumar, President of the Association. Two years ago, with the backing of the association a nurse filed a PIL after a Delhi private hospital refused to return her certificates. She had to quit the job to look after her terminally ill mother but the hospital would not accept her resignation.

When the case reached the Supreme Court earlier this year, the judges responded with similar shock. “’They take your certificates away? The judge couldn’t believe it,” smiles Krishna Kumar. In May 2012 the Supreme Court instructed state and central government to frame guidelines so that hospitals cannot hold a nurse’s certificates hostage. It hasn’t happened yet. Krishna kumar’s organisation lobbies on for a comprehensive policy for the nursing services.

Krishna Kumar is a bit bemused as the association she set up gallops in ambition and scale. Other nurses’ associations have sprung up all over India in the last few years too. Strikes have become more common. These are unusual developments in a profession where in the past, no nurse has had the patience for organising. You may live together six to a house, go to church together, eat together, shop together, survive together, but the present was secondary. The present was no time for extravagances like union work. Today, as traditional employers like the US and Middle East employ more and more of their own citizens as nurses, is it possible that the Malayali nurse will bring her pragmatism home? Perhaps. But as one popular door closes, another opens somewhere more obscure, in Tripoli, for instance. A door through which can be seen a life where you can be proud to be a nurse.

As a person who has spent a significant part of his professional life in hospital and healthcare environment responsibly, I can vouch for these precious little angels sprinkled all across the globe by the one divine mercy.

Be it Turkey, Tokyo, Tennessee, Tasmania or Toronto, in every abyss of doom and despair that man fall in during a medical situation, a little sparkle of hope and rejuvenation might glitter around; those very naive sisterly (and brotherly) hands a Keralite is accustomed to at his homeland.

Kudos to you, oh brothers and ladies! You are true ambassadors of peace from the God's own land, that we also call Kerala.

It's the first time I am reading such an article about malayali nurses that too with a global insight. Hats off to Ms.Nisha Susan for doing such a research about nurses of Kerala origin. Being a nurse (of course I am Male) with more than 10+ years of nursing experience in various hospitals in India and now in Kuwait; I felt like she is telling about some one I know, smeone I worked with ,my colleagues or about some of the situations I faced in my nursing career.

The only complaint I have about this article is it's about 'female' malayalee nurses. But nurses are nurses. Whether female or male they study same syllabus and do the same job. The only difference is nursing is a multy skill job and males may perform better in some skills and females may perform better in some other skills.

In my opinion it's an award winning piece of journalism based on true facts.

'She is everywhere, so it becomes difficult to see her'.... heart touching words. Once again thanks to the journalist- NISHA SUSAN

Thank you! This is a beautiful homage. I'm so glad that there are people who are willing to notice all this and to take the trouble to synthesize thoughts, media references, news, etc to create such a powerful whole. Many years ago, when Mother Theresa died, Gloria Steinem wrote a short piece about the nuns who worked with her, who really carried the brunt of the day-to-day stuff but got no recognition. Your piece is similarly one for the books.